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The ACA MarketplaceS

Change in February effectuated enrollment, by state, 2025-2026

How Has ACA Marketplace Enrollment Changed Across States in 2026?

ACA Marketplace enrollment fell this year in every state except New Mexico, which was the only state to fully replace the enhanced premium tax credits that expired last year with a state-funded subsidy, according to a new KFF analysis of effectuated enrollment data. The Marketplace enrollment decline—the first in seven years—follows several years of rapid enrollment growth and coincides with the end of the enhanced federal subsidies.

How Much and Why ACA Marketplace Premiums Are Going Up in 2027

ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years.

About the ACA

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Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

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  • Pulling It Together: Predictions

    Perspective

    I usually don’t make predictions, unless they are backed up by the kind of statistical modeling we often produce.  But here are three predictions I am confident about that form the basis of this latest column. GROUP HEALTH INSURANCE PREMIUMS WILL CONTINUE TO RISE AT HISTORICALLY MODERATE LEVELS, AT LEAST FOR THE NEXT FEW YEARS.  One reason for this is the lingering effect of the recession.  Employers will have little trouble attracting workers in the…

  • Pulling It Together: Writing Regulations

    Perspective

    Not since Geraldo Rivera revealed the secret contents of Al Capone's vault on national TV in the mid-80s, or more recently, sports fans awaited the LeBron James "decision" about where he would play next, have we so anxiously awaited anything as much as the draft health exchange regulations just published by HHS. Well, okay, I exaggerate for effect, but the regulations on health insurance exchanges were anxiously awaited by the health policy community. The hallmark…

  • How Is The Primary Care Safety Net Faring in Massachusetts? Community Health Centers In The Midst of Health Reform

    Report

    This report examines how community health centers, which provide comprehensive primary care for low-income and uninsured patients, have fared under Massachusetts' health reform law. Community health centers saw a significant increase in patient load amid the state's efforts to improve health coverage by expanding public programs and making private insurance more affordable. That experience shows that community health centers play a critical role in caring for newly insured patients while continuing to serve as the…

  • Coverage of Preventive Services for Adults in Medicaid

    Issue Brief

    This brief highlights data from a survey of coverage of 42 recommended preventive services for adults in Medicaid fee-for-service programs as of October 2010. Medicaid programs must cover preventive services for children as part of the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, but generally are not required to cover such services for adults. The Affordable Care Act (ACA) provides states the opportunity to earn a one percentage point increase in their federal matching…

  • ¿Hay alguna razón por la que el mercado no ajustaría y continuaría automáticamente mi subsidio para la prima al momento de la renovación?

    FAQs

    Si vive en un estado que utiliza cuidadodesalud.gov , cuando solicitó cobertura por primera vez, tuvo la oportunidad de autorizar al mercado a consultar sus datos de ingresos en línea, incluyendo sus declaraciones de impuestos, durante 1 a 5 años. Si no lo autorizó, su asistencia financiera NO se renovará automáticamente para el próximo año, y debe volver a aplicar. Si vive en un estado que opera su propio mercado de seguros, el proceso para…

  • ¿Hay momentos especiales para inscribirse en el mercado para las personas que han perdido Medicaid o CHIP?

    FAQs

    En los estados que usan cuidadodesalud.gov, el período especial de inscripción actual debido a la pérdida de Medicaid o CHIP se extenderá de 60 a 90 días. Esto significa que los consumidores tendrán hasta 90 días después de la pérdida de esos beneficios para inscribirse en el mercado de seguros. En los mercados de seguros estatales, el período especial de inscripción tras la pérdida de la cobertura de Medicaid o CHIP es de 90 días;…

  • I don’t have a checking account. Can the insurance company require that I get one and pay my premiums through automatic monthly withdrawals?

    FAQs

    No. Insurers offering coverage in the Marketplace are required to provide a variety of payment methods and cannot require a consumer to pay by automatic bank withdrawals (sometimes called electronic funds transfers, or EFT) or debit card. Federal rules require the insurer to also accept paper checks, cashier’s checks, money orders, and general-purpose pre-paid debit cards. These methods must be available to consumers for both the initial premium payment (at enrollment) and ongoing payments.

  • No sé cuánto tiempo hace que terminó mi Medicaid. ¿Hay una fecha límite para solicitar la cobertura del mercado?

    FAQs

    Sí, el período especial de inscripción por pérdida de Medicaid o CHIP es de 90 días en la mayoría de los estados. Esto significa que los consumidores tendrán hasta 90 días después de la pérdida de Medicaid o CHIP para inscribirse en el mercado de seguros. Si no solicita la cobertura del mercado dentro de este plazo, podría tener que esperar hasta el próximo período de inscripción abierta para hacerlo. Los estados que administran sus…

  • Calculo que mis ingresos el próximo año serán muy bajos, así que necesito pagar por adelantado todo el subsidio para las primas. Si, para fin de año, resulta que mis ingresos anuales fueron incluso meno...

    FAQs

    No, el monto final de su subsidio para las primas se determinará en base a sus ingresos del año, según lo declarado en su declaración de impuestos. El hecho de que haya sido menor de lo esperado no significa que tenga que devolver el subsidio que recibió por adelantado, incluso si hubiera podido calificar para Medicaid. De hecho, el monto final de su crédito probablemente sea mayor que la cantidad que recibió por adelantado. (Esto…